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Understand the Basics of ICD-10 Codes Structure

June 29, 2015

ICD, Internal Classification of Diseases, created by the World health Organization, is a coding system to maintain a standard diagnostic tool for epidemiology, management of health and clinical purposes. It has been in use for over 150 years, and helped track morbidity and mortality rates. Given the rate of the changing disease patterns, the ICD codes are regularly revised keeping in sync with advances in the medical field and technologies employed.

The ICD-10 coding is a revised tool to document patient diagnosis and inpatient procedures. The ICD-10 codes will be put to use for all those covered by both, the Health Insurance Portability Accountability ACT (HIPAA) and those who submit to Medicare or Medicaid claims. The ICD-10 coding has been very simply divided into two parts:

ICD-10-CM which will help in diagnostic coding in the US for all health care settings

ICD-10-PCS which will aid in inpatient procedures coding and used in all US hospital settings

To understand the basics of ICD-10 coding all one needs to know is:

The ICD-10 has 68,000 codes whereas ICD-9 had just 14,000 codes

The alpha numeric codes now have 7 characters instead of the earlier ICD-9 limited 3-5 codes

Of the 7 characters, the first character is always alpha except the alphabet ‘U”, characters 2 -7 are alpha numeric.

The first 3 characters represent the category, the next 3 characters – etiology, anatomical site, and severity, and the last character, the 7th, is used as an extension of the disease if prevalent in certain chapters only

Certain basic similarities have been retained but certain differences based on the chapters have been introduced to give more specificity to the medical problems

The ICD-10 transition from ICD-9 has been given the date as of October 01, 2015. It is not smooth sailing, as it involves a whole lot of updating to be done to the systems and trainings conducted for health coders and providers. The transition, after three decades, will involve a massive operational, technical, and business execution in the health care industry. This transition will provide greater specificity and clinical accuracy when diagnosing, as it provides a more logical structure, and eventually push towards better electronic coding tools for faster code selection. It has become absolutely necessary for all those covered under the HIPAA, especially those who transmit electronic claims to switch to Version 5010 transaction standards. Moreover, the transition will also benefit payers as it will help in accurately defining services to be paid.

The Centers for Medicare and Medicaid Services (CMS) has been constantly providing updates on ICD-10 coding information via different portals, as well as via media, such as videos and presentations, and web-based learning courses.

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The impending transition to ICD-10, one of the most crucial changes in healthcare, the new coding system is here. MBC’s professional services in ICD-10 can help you with end-to-end solutions for a successful implementation.